I want natural looking breasts with little scarring. Which is better: under the muscle or over? Saline or silicone? (Photo)

i wanted to find out if im a better candidate for under or top of the muscle and which to use saline or silicon?i want a really natural looking breast with out it feelig fake with little scaring.im 27 years old with a 7 year old son whom i breast feed for 6months.

Doctor Answers 19

Choices for "Natural" Looking Breasts?

Unfortunately, before entering into the discussion of the risks/benefits of implant material or position, you need answer the question of whether you are willing to accept the additional scars of a breast lift.
While is difficult to tell for certain just on the basis of photographs, you look like you will need a breast lift to achieve an aesthetic breast appearance. It appears that your nipple position and more than half of your breast tissue lies below the level of the fold under your breast which usually indicates the need for a breast lift. Also your areola is significantly enlarged, and this can be reduced in size when a lift is done. But lifts require some significant additional scars which most people, understandably, wish to avoid.

As far as getting a natural looking breast, different individuals can have different preferences for their optimal natural appearance, but in general putting an implant under the muscle tends to produce a more natural result, and silicone gel implants tend to look more natural particularly for someone with very little breast tissue. You however have a good amount of breast tissue, so you can potentially get a good aesthetic result with either saline or silicone as long as you don't choose an overly large implant. The bigger the implant, the more it will stretch your tissues, and the more it will tend to look fake, and the more easily it will be felt through your tissues.

Sometimes patients will be told to put a larger implant on top of the muscle in order to avoid having to do a lift. I think that would be bad advice in your situation. Your breast already sits low on your chest wall, and placing an implant low to try to "lift" your breast will not result in a natural looking result, and your skin and breast tissue will not support the implant and you will soon have a large saggy breast which likely not the result you are looking for. So the issues of implant location and gel vs saline are only two small components of the overall decision process required for you to achieve a good result.

Lift more important than implants

Augmentation alone may be inadequate.You will need a lift and I recommend a new technique called Breast Augmentation with Mini Ultimate Breast Lift™.Using only a circumareola incision it is possible to reshape your breast tissue creating upper pole fullness, elevate them higher on the chest wall and more medial to increase your cleavage.Through the same incision, implants can be placed.Aligning the areola, breast tissue and implant over the bony prominence of the chest wall maximizes anterior projection with a minimal size implant.Small round textured silicone gel implants placed retro-pectoral look and feel more natural, are more stable, less likely to ripple or have complications needing revision.Implant profile is irrelevant in the retro-pectoral position since the muscle compresses it.More important than the implant is the lift.If you are satisfied with your breast volume then you do not need implants.

Best Wishes,

Gary Horndeski, M.D.

Gary M. Horndeski, MD
Texas Plastic Surgeon
4.7 out of 5 stars 208 reviews

Natural breasts with Sientra textured shaped implants

After 10 years using the gummy bear implants, in my opinion, the Sientra highly cohesive silicone gel that are textured round based shaped implants are the best of the best.  They can be placed underneath the muscle, which in contrast to other's comments is the most common approach, with the least risk, do not move lateral, best for mammography, and have a one breast feel.  You will however, need a mini-lift or breast lift in addition to your breast augmentation.

Peter J. Capizzi, MD
Charlotte Plastic Surgeon
4.8 out of 5 stars 79 reviews

Right best for most natural look

The most natural look (and least painful recovery) is implants over the muscle.
Saline implants are fine - you have plenty of breast tissue to cover them.
Gel implants will look and feel more natural.

Your breasts however have significantly drooped.
I am concerned an implant alone will not give you the look you want.

I suggest you discuss the pros/cons of a short scar breast lift with or without implants.
If you have a mastopexy - the implants will go under the muscle to minimize the risk of infection. Best wishes.

Pros and cons to both saline and silicone

There are a lot of questions you need answered. First off, your plastic surgeon can give you a natural look with augmentation and your breasts will look and feel natural. You have several issues with your breast as depicted by the photos you attached. You have post gestational sagging and splaying of the areolas (nipple area). I would recommend a breast lift (mastopexy), reduction of the nipple (areola) and correction of the breast symmetry. You can do the augmentation and other procedures together or stage the surgeries. First, place the implant. I would do it under the muscle and let it settle for 6 months, then plan the lift. This would require a lollipop incision. There are pros and cons to both saline and silicone. You can use either one. However, the highly cohesive silicone implants will not feel fake. Do not undergo surgery unless you are done with childbirth. Wait until your family is complete.

Michael Stefan, MD
Philadelphia Plastic Surgeon
5.0 out of 5 stars 4 reviews

Modest ptosis can be corrected with breast augmentation.

The breasts appear to have a modest amount of ptosis. For most patients I would recommend silicone gel implants in a sub glandular position.

Vincent N. Zubowicz, MD
Atlanta Plastic Surgeon
4.9 out of 5 stars 32 reviews

Natural looking breast augmentation

Generally speaking silicone gel breast implants placed beneath the chest muscle tend to be the most natural looking when done properly.

However based on your photograph you will need a breast lift for the best possible result.  Your nipple areola is lower than your inframammary crease and the breasts will have to be lifted in order for the implant to be placed beneath the chest muscle.

For more information on combining breast lift and augmentation please read the following link:

Natural looking breasts after surgery

Your comments and pictures require a thorough consultation with a board certified plastic surgeon. It appears from your pictures that you will need both breast augmentation and a breast lift. Therefore, discussion about the breast lift options and scarring associated with them needs to take place. In addition, you should participate in a discussion about the pros and cons of saline versus silicone implants as well as their location options.  

Need a Breast lift

After viewing your photographs you are not a good candidate for a breast augmentation alone.  You most definitely need a breast lift.  If you want improved upper pole fullness then you could consider a implant but the lift is a must.  

Jeffrey Zwiren, MD
Atlanta Plastic Surgeon
4.5 out of 5 stars 16 reviews

Natural looking breast augmentation with little scars

Thank you for your question and photos.  The question you have asked requires a very in-depth discussion about what your specific goals are.  The best place for this discussion is in person with your plastic surgeon.  A couple of ideas.......Rather than being a candidate for above or below the muscle, the discussion should center on the benefits of above or below the muscle.  Either place is possible, but there are distinct advantages and disadvantages to both. The majority of the time, I place implants below the muscle because we see less scar tissue forming around the implants in this location.  As far as saline or silicone, silicone implants are a better overall implant for feel as well as having less rippling along the edges of the implant.  That means you feel the implant less and thus end up with a more natural feel to the breast.  Finally, because of the degree of sag in your breasts, you would be best served with a lift at the time of the augmentation.  The trade-off of a lift is improved shape of the breast for scars.  Seek the advice of a board certified plastic surgeon who can help guide you through this process.
Best of luck.

Brian C. Reuben, MD
Salt Lake City Plastic Surgeon
5.0 out of 5 stars 26 reviews

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.